Provider Demographics
NPI:1225216971
Name:RYAN-BODEN, SYLVIA (OD)
Entity Type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:
Last Name:RYAN-BODEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SYLVIA
Other - Middle Name:
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:3370 E CANARY WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-5682
Mailing Address - Country:US
Mailing Address - Phone:480-899-6464
Mailing Address - Fax:480-899-0199
Practice Address - Street 1:2974 N ALMA SCHOOL RD
Practice Address - Street 2:STE 3
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6713
Practice Address - Country:US
Practice Address - Phone:480-899-6464
Practice Address - Fax:480-899-0199
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ850152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1225216971OtherPROVIDER NPI
AZ1225364110OtherCORPORATE NPI
AZ61935Medicare UPIN